autobiography in five short chapters · autobiography in five short chapters 1. i walk down the...
TRANSCRIPT
Autobiography in Five Short Chapters
1. I walk down the street.There is a deep hole in the sidewalk.
I fall in.I am lost…I am helpless.
It isn’t my fault.It takes forever to find a way out.
2. I walk down the same street.There is a deep hole in the sidewalk.
I pretend I don’t see it.I fall in again.
I can’t believe I am in the same place.But, it isn’t my fault.
It still takes a long time to get out.
3. I walk down the same street.There is a deep hole in the sidewalk.I see it is there.I still fall in... it is a habit
My eyes are open.I know where I am.
It is my fault.I get out immediately.
4. I walk down the same street.There is a deep hole in the sidewalk.I walk around it.
5. I walk down another street.-- Portia Nelson
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Why don’t people do what we tell
them to?
Rachel Green, Ph.D., MINT
dancing gecko training
How can we help them to change?
Who am I?
Trained as a neuropsychologist, I wasinfected by Motivational Interviewing in 2006, and became an MI trainer in 2008. I am stillnot cured.
Founder of dancing gecko training throughwhich I offer MI workshops and ongoingclinical development with my coding lab to various centres, I also have a private practice where I am regularly amazed by my clients’ ability to find creative solutions to their ownproblems.
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Before I forget…
Cell phones
Schedule
Presentation
Handouts
How to reach me
438-878-0504
www.motivational interviewingmontreal.org
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LET’S TALK ABOUT CHANGE
How do you feel? What helps, what doesn’t? How
long does it take, anyway?
Today’s training objectives
On the menu:
Talk about how MI may be a useful approach to
help people get to changing their vaccination
behaviour.
Give you the definition, and a little bit about the
values and spirit of MI—remember, this is just a
taste!
Offer a chance to play with MI through exercises
Pique your curiosity to learn more about MI
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Your Patient
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ORProblem-solving mind
Gently curious mind
AN MI CONVERSATION ABOUT
VACCINATIONS
With Margie Danchin
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What do you know already?
About Motivational Interviewing
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Definition of MI
Motivational Interviewing is a collaborative,
goal-oriented style of communication with
particular attention to the language of
change. It is designed to strengthen
personal motivation for and commitment to a
specific goal by eliciting and exploring the
person’s own reasons for change within an
atmosphere of acceptance and compassion.
W.R. Miller & S.Rollnick, Motivational Interviewing, 3rd ed. 2013
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Where did MI come from?
Miller and Rollnick, early 1980s (alcohol
misuse)
Carl Rogers’ Humanism
Evidence-based and research driven
NOT the transtheoretical (stages of
change) model
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At the heart of MI
SpiritFour Processes
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At the of MI spirit
Respect
Compassion
Acceptance – unconditional regard, belief in the abilityand the right of the other to make good decisions for him/herself; accurate empathic listening, affirmation
Partnership – a “paw de deux”
Evocation – Listen and solicit
Autonomy– The right and the ability to make good choices for oneself.
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WHAT IS COMPASSION?
What is compassion?
Thich Nhat Hanh: wanting to free others from suffering.
Compassion is often regarded as emotional in nature, and there is an aspect of compassion which regards a quantitative dimension, such that individual's compassion is often given a property of "depth," "vigour," or "passion. The etymology of "compassion" is Latin, meaning "co-suffering." More virtuous than simple empathy, compassion commonly gives rise to an active desire to alleviate another's suffering. It is often, though not inevitably, the key component in what manifests in the social context as altruism. In ethical terms, the various expressions down the ages of the so-called Golden Rule embody by implication the principle of compassion: Do to others what you would have them do to you.[1]
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A few quotes about compassion
“Our task must be to free ourselves... by widening our circle of compassion to embrace all living creatures and the whole of nature and it's beauty.”
Albert Einstein
“If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”
Dalai Lama XIV “Compassion is a verb.”
Thich Nhat Hanh
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Acceptance
Acceptance of the client and his/her values
facilitates change;
Acceptance does not necessarily mean being
in agreement with;
Unconditional regard for, rather than
judgment of, your client is part of acceptance;
Accurate empathetic listening is a path to
acceptance.
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PARTNERSHIP
Find a partner!
Partnership
Rather than telling the client what to do;
find out what s/he wants to do
Explore other possibilities with the client
without imposing them.
Enquire about the client’s own solutions
Offer a menu of options if solutions are not
forthcoming
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Evocation
What’s your perspective? What is your client’s?
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Responsibilities in MI
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Therapist client
The worker is responsible for the intervention,
not the outcome!
Giving information the MI way:
E-P-E Elicit
Ask what the person knows already about his/her situation or condition. Affirm their knowledge/open-mindedness/attitude.
Ask permission
If there are gaps in his/her knowledge, ask permission to give more information
Provide
Provide the missing information
Elicit
Ask what, if any, effect the new information has had on the client’s thinking about his/her situation/condition
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Why don’t patients just do
what we tell them?
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ELICIT-PROVIDE-ELICIT
Pair up!
Pick a subject, any subject…
Choose a subject about which you know
quite a bit.
Find a partner who has chosen a
DIFFERENT subject.
Elicit-Provide-Elicit
Therapist…
…shows his/her card to client who will act as
if s/he has come to consult about this subject.
…asks what the client already knows about
that subject.
…offers an affirmation and then asks
permission to tell client more.
…provides the information, then asks client
for his/her feedback about what impact, if
any, this info has..28
Elicit-Provide-Elicit
Client
…acts as if s/he has come to consult about this
subject.
…replies naturally to the question of what you
already know about the subject
If you already know a lot, please restrain yourself a
little to give your partner room to talk.
…replies in the positive when asked for your
permission.
…replies naturally to the final question.
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MI Skills-OARS – nothing new?
Open(-minded) Questions
Affirmations of competences, values and
qualities
Reflections
Summaries
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MI Skills-OARS
Open(-minded) Questions
Questions that can not be easily answered by
one word (i.e., yes/no, Tuesday, etc.)
Questions that elicit elaboration from the
client
Questions to which you do not yet know the
answer
…as opposed to closed questions
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What’s the qualitative difference between
an open and a closed question?
I need to get more exercise.
Have you tried X? vs. What have you
tried?
Do you need to get more exercise to lose
weight? Vs. Tell me more about needing to
get more exercise.
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The greatest gift
we can offer anyone is
our true presence.
Thich Nhat Hanh
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PRESENCE
Pair up!
Presence
Speaker
Speaker will speak about
what compassion means
to him/her and how s/he
sees the relationship of
compassion with his/her
work or life OR reflect on
what is written on the
cards.
If you run out of things
to say, just sit in each
other’s presence in
interested silence
Listener
Listener will give
Speaker his/her full
presence:
listening with soft
eyes, open ears, all
his/her heart, and a
sense of delight
RECEIVE!
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MI Skills-OARS
Accurate Empathic Reflections--Simple and
Complex
Focusing all of one’s purpose, attention,
and energy on understanding what the
person’s message means to the him/her
using reflections rather than questions
A reflection is always in the form of a
statement; the voice goes down at the end.36
Simple Reflections:what is the person saying?
Repetition: exact repetition of the speaker’swords.
Reformulation: Slight changes in some of the speaker’s words, but no added meaning
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Complex Reflections:
what does the person mean?
Emotion: You feel that…
Values: It is important to you that…
Amplification: So, this (behaviour) doesn’t cause you anyproblems.
Minimisation: (in response to catastrophic discourse, ex. Mylife is a total disaster!) This is a difficult time for you right now.
Double-sided: Two opposing statements (ex. On the one hand… and on the other hand…)—two contrasting ideas with “and” in the middle.
Coming alongside: No one can tell you what to do. You need to be a full partner in this process.
Metaphor: It is as if…
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What’s underneath ambivalence?
Sovereignty (Power)
Belonging
Being lovable, Loving
Capability
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Yeah, but what’s
underneath that?
The four fears:
Abandonment
Engulfment
Shame/inadequacy/failure
Loss/death
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MI Skills-OARSTaylor Mali (typography by Ronnie Bruce)
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INTEREST
Pair up!
Interest
Speaker
Speaker will speak about
his/her hopes and
dreams
Listener
Listener will give Speaker
his/her full presence
And using simple and
complex reflections, reflect
what the speaker is saying/
meaning, deepening
his/her understanding of
what is important to the
speaker.
No QUESTIONS
permitted!
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Affirmations: tell me something
good strong and specific!
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MI Skills-OARS: AffirmationsAffirmations can include:
Noticing, recognizing and acknowledging positively an attribute, action or intention You got to the CLSC to renew your Medicare Card. That’s
something that you have been meaning to do for awhile.
Reframing the client’s actions in a positive light Although you had hoped to lose 5 pounds this month and
you’re feeling disappointed that you only lost 3, you have managed to change your eating habits.
Catch the person doing something right Thanks for coming in today, I know it is sometimes tough
for you to get here.
The more specific the affirmation, the more powerful!
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MI Skills-OARS: Summaries
Summaries can…
Collect material that has been offered
So far you’ve expressed concern about your being on this medication for life, being able to afford it, and the possible side effects you might experience.
Link something just said with something discussed earlier.
That sounds a bit like what you told me about that feeling you get that you are “handicapped”.
Draw together what has happened and transition to a new task
Before I ask you the questions I mentioned earlier, let me summarize what you’ve told me so far to see if I’ve missed anything important. You joined this program, because you were feeling really sick, and it scared you…
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The Process of Change
Ambivalence
Discord/sustain talk
Desire
Ability
Reason
Need
Commitment
Activation
Taking steps
CHANGE!
Change talk(Initial phase)
Commitment talk(more developed)
How do you start your
conversation?
How do you keep it on target?
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Process of an MI Conversation
“ Structure”
ExpressEmpathy
Develop Discrepancy/Amplify Ambivalence
OARS Change Talk/ “Change Theory”
Change Plan
CommitmentLanguage
Target/purpose
Four processes of MI
Engagement
Evoking
Focusing
Heightening Ambivalence
Planning
Empowerment
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DreamsFinancial
Health
Diet
Family
and
Children
Tobacco
Use
Work
Spiritual
Practice
Physical
Health
YOU?
Education
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HOW ARE WE DOING SO FAR?
Comments, questions, cries of outrage?
Before you leave…
I liked…?
I will use…?
I will ignore…?
Thank you for inviting me!
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